Julie, Elliot’s mother, found out about his heart problem during a prenatal ultrasound 22 weeks into her pregnancy. She was told that her baby’s heart was pumping at an extremely high rate, over 200 beats per minute.
She was quickly referred to Marie M. Gleason, MD, FAAP, FACC, an Attending Cardiologist and Director of the Children’s Hospital of Philadelphia (CHOP) cardiac outpatient operations. Dr. Gleason confirmed that the racing pulse was supraventricular tachycardia (SVT), an arrhythmia, or rapid heartbeat.
A week later, the heartbeat was getting even faster. After advanced testing, including additional high-resolution ultrasounds and a fetal echocardiogram, Julie was put on digoxin, a medication used to slow heart rate, which is absorbed by the developing fetus.
Monitoring Julie’s progress
If SVT is left untreated, the heart beats so fast that it cannot effectively pump blood to the body. The developing baby can go into congestive heart failure before birth. In severe cases, the condition can be fatal. Julie’s medical team with CHOP’s Fetal Heart Program would have to closely monitor her pregnancy.
The treatment worked to get Elliot’s heart rate down to a safe level, and Julie took the medication for the rest of her pregnancy. She had regular ultrasounds and echocardiograms to observe her progress.
Because the SVT caused a significant cardiac risk in her baby, Julie underwent a scheduled c-section at 37 weeks near their home. The baby’s care was managed by CHOP cardiologist R. Lee Vogel, MD, at the Lancaster General Hospital newborn intensive care unit (NICU).
CHOP has a collaborative agreement with Lancaster General Health, under which CHOP pediatric hospitalists and cardiologists provide inpatient care in Lancaster General Hospital’s Pediatric Unit and Emergency Department. CHOP cardiologists offer outpatient services at the Suburban Outpatient Pavilion, and CHOP neonatologists provide care in the Neonatal Intensive Care Unit (NICU) at Women & Babies Hospital.
To the relief of his parents and his medical team, Elliot’s heart rate was in the normal range at birth and stayed there for the four days he was monitored in the NICU. Julie is a nurse, so on Elliot’s release, she was given instructions to check his heart rate several times a day with a stethoscope and told what danger signs to watch for.
Elliot was fine for his first few days, but after a week at home, his heart rate rose above 200 beats per minute and stayed at the high level for an hour. That was one of the danger signs Julie and her husband, Mark, had been watching for, so they brought Elliot to CHOP.
Treatment for Elliot
Elliot was admitted to the Cardiac Care Unit, where he was monitored closely by cardiologists in the Electrophysiology and Heart Rhythm Program and treated with medication to bring his heart rate down. Over the course of the next three weeks, different medication doses were tried so that the medical team could recommend the most effective combination of drugs to treat Elliot:
- Propranolol – a beta blocker used to treat irregular heart rate and other conditions.
- Digoxin – used to slow heart rate, the same drug he had received in utero.
- Flecainide – an antiarrhythmic agent.
During his three-week stay, Elliot’s diagnosis was revised by the electrophysiology team. It was determined that Elliot actually had persistent junctional reciprocating tachycardia (PJRT), a relatively rare form of SVT, where heart rates generally slow down with age. A surgical procedure called ablation can be used to correct the condition, but it carries extra risk when done at an early age. The procedure is generally put off until the child is older because it can be done with a greater chance of success when the heart is larger and because many children naturally “grow out of” the condition.
The combination of medications worked to reduce the periods of racing heartbeat, and Elliot was released to his parents’ care at home. To monitor Elliot’s progress, doctors showed his parents how to do monthly electrocardiogram (EKG) tests at home using a Holter monitor with electrode pads and a recording device to be sent to CHOP for analysis. They were also instructed to continue checking Elliot’s heartbeat several times a day with a stethoscope.
Over the next few months, Elliot had no extended periods of extremely high heart rate. The monthly EKG tests showed that short bursts still occurred, but they were limited to 3-4 percent of each 24-hour period. The combination of medication continued to work for Elliot as he grew bigger. By the time he was 6 months old, his doctors began to wean him off the antiarrhythmic agent he was on.
A happy baby
Now at 8 months, Elliot is a contented baby. He sits and plays with toys, blows raspberries to get a laugh from his parents, and beams especially brightly when jazz music is playing or he’s taken outdoors.
Over the next few years, his medical team at CHOP will continue to work with his parents to monitor his heart rate and determine whether additional treatment is needed.
“I don’t even have words to express how great CHOP was for us,” Julie says.
“His nurses were phenomenal. They loved Elliot like he was their own child. I would be sitting in Elliot's room crying and they would come in and comfort me. They were like family.”